| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
201 |
196 |
$4K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
58 |
57 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
110 |
110 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
50 |
46 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
25 |
25 |
$2K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
12 |
12 |
$1K |
| 92250 |
|
26 |
25 |
$851.50 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
75 |
75 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
117 |
117 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
23 |
23 |
$0.00 |
| V2020 |
Frames, purchases |
123 |
123 |
$0.00 |